Relationship between cardiovascular reactivity to mental stress and early target-organ damage in untreated mild hypertension. Hospitalet Study

BACKGROUND: It has been previously reported that an exaggerated response of blood pressure to mental stress tasks is associated to an increased cardio vascular risk. The objective of this cross-sectional study, with sequential inclusion of subjects who met the inclusion criteria, was to asses the rel ationships between the response of blood pressure and heart rate to two dif ferent mental stress tasks and early target organ-damage, defined as abnorm alities in the echocardiogram and/or an increase of urinary albumin excreti on (UAE) or microalbuminuria, in untreated mild hypertensive subjects. SUBJECTS AND METHODS: TWO hundred and eleven subjects aged 18 to 65 years ( 56% males) with mild hypertension (SBP between 140-180 mmHg and/or DBP betw een 90-105 mmHg) were included in Hospitalet Study. One hundred and thirty seven of them accepted to participate in the study of cardio vascular react ivity. Two different tasks were applied in the same day: a stressful interv iew (SI) and a mental arithmetic stress tasks (MAST). An echocardiogram of good quality was obtained in 123 cases (89.8%) and 24 h UAE was measured in 108 cases (78.8%). RESULTS: The prevalence of left ventricular hypertrophy was 21.1% (95% CI = 14.3-29.4) and the prevalence of microalbuminuria was 15.7% (95% CI = 9.4- 24.4%). After adjusting for the baseline blood pressure, a significant corr elation was observed between increase of systolic BP during SI and UAE (r = 0.21; p = 0.03) and between increase of diastolic BP during St and relativ e wall thickness (r = 0.32; p < 0.005). When we analyzed the changes of BP during MAST, a significant correlation was observed between increase of dia stolic BP (adjusted for baseline diastolic BP) and left atrial size (r = 0. 21; p 0.02). We did not find any significant correlation between the increa ses of BP (systolic or diastolic) during MAST or increases of heart rate du ring both tasks and left ventricular mass index or UAE. CONCLUSIONS: A weak correlation was observed between cardiovascular reactiv ity of blood pressure during mental stress tasks and early target organ dam age in mild hypertension. We did not find any relationship between the resp onse to heart rate during the tasks and early target organ damage.